The Risk of HIV/STDs Infection and Transmission Among Never-Married Male Migrants in China: Is Risk Attributable to Bachelorhood or Migration?

Sexual behaviors and HIV-related knowledge among GBMSM: evidence from 2011 to 2021 in Hangzhou, China

INTRODUCTION

Considering that many new HIV infections are transmitted by homosexual behaviors, gay, bisexual, and other men who have sex with men (GBMSM) are more likely to be infected with HIV than other groups due to the higher risk associated with unprotected anal intercourse. It is important to explore the changes in sexual behaviors and HIV-related knowledge among GBMSM in the last 10 years, which could provide evidence for improving public health interventions to reduce HIV infections.

OBJECTIVES

The study sought to explore the changes of 3 sexual behaviors and HIV knowledge among men who have sex with men from 2011 to 2021.

METHODS

Data were collected from national HIV sentinel surveillance among GBMSM in Hangzhou conducted between 2011 and 2021. Univariate and multivariate logistic regression were used to analyze the associated factors of sexual behaviors. The variation trend of variables was evaluated based on the linear trend test in the regression model.

RESULTS

A total of 5111 GBMSM with an average age of 32.00 years were incorporated in the analysis. From 2011 to 2021, the HIV-related knowledge score of GBMSM ranged from 6 to 7.5, and it increased significantly (P trend < .001). The rate of homosexual sex in the past 6 months remained at a high level (75.06%-82.75%). Homosexual behavior was associated with a higher HIV-related knowledge score (P = .004). Heterosexual sex was associated with an increase in the old age, married persons, and domicile outside the province (P < .05). Commercial sex was associated with an increase in drug users (P <.001).

CONCLUSIONS

In the past 10 years, HIV-related knowledge of GBMSM increased and the rate of unprotected sex was at a high level among GBMSM, especially in heterosexual behaviors. Moreover, the likelihood of having homosexual behaviors is raised with the increasing HIV-related knowledge. Conducting precise behavioral interventions for GBMSM are crucial for preventing HIV infection.

The Vulnerability of International Floating Populations to Sexually Transmitted Infections: A Qualitative Study

With the rapid development of the global economy, along with globalisation, the health of international floating populations (especially their sexual health) has become a problem that cannot be ignored. This study explored the potential vulnerability of international floating populations to sexually transmitted infections (STIs) from the points of view of society, religion, culture, migration, community environment, and personal behaviours. In-depth exploratory interviews with 51 members of the international floating population living in China were conducted in June and July 2022. A qualitative thematic analysis methodology was used to analyse the content of these interviews. We found that a conservative culture orientated around religion leads to a lack of sex education, resulting in insufficient personal knowledge as well as a lack of the motivation and awareness required to encourage condom use during sexual contact. Additionally, both geographical isolation and reduced social supervision have expanded personal space, which has led to social isolation and marginalisation, in addition to challenges for coping with STI risk. These factors have increased the possibility of individuals engaging in risky behaviours.

How Does Migration Affect HIV Sexual Risk Behaviors Among Involuntary Bachelors? The Mediating Roles of Neighborhoods and Social Networks

The sex ratio imbalance in China since the 1980s has resulted in a large number of involuntary bachelors in rural China. Previous studies have found an association between migration and HIV sexual risk behaviors among involuntary bachelors, but how migration affects these bachelors' HIV sexual risk behaviors remain poorly understood. Using data from a cross-sectional survey in 2017 (a sample of 740 male respondents who had rural household registration, had never been married, and were aged 28-49 years), we investigated the relationship between migration and HIV sexual risk behaviors. Logistic regressions show that migration, neighborhood characteristics, and social networks were significantly associated with commercial sex and multiple sex partners, whereas only neighborhood characteristics and social networks were positively correlated with sexual partnership concurrency. Neighborhood characteristics and social networks mediated the relationships of migration with commercial sex and migration with multiple sex partners. Social networks mediated the association between neighborhood characteristics and concurrency. Multiple-step mediation analysis showed that the indirect effect of migration on commercial sex and multiple sexual partners through neighborhood characteristics and social networks was significant. Our findings suggest that further interventions should address neighborhood characteristics and social networks together.

Prevalence of syphilis and chlamydia trachomatis infection among female sex workers in Jiangsu, China: Results from a multicenter cross-sectional and venue-based study

Background

Female sex workers (FSWs) are considered highly vulnerable to sexually transmitted infections (STIs), but available data on the prevalence of STIs among FSWs in China is limited at a provincial level. This study aimed to evaluate the prevalence of STIs and risk factors among FSWs in Jiangsu, China.

Methods

We conducted a multicenter cross-sectional study in seven cities of Jiangsu to investigate the prevalence and risk factors associated with HIV and other STIs. Blood and urine were collected to test for HIV, syphilis, Hepatitis C (HCV), Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections.

Results

We enrolled 3,580 FSWs. The overall prevalence of bacterial STIs was 6.2% (5.4%-7.0%). The prevalence of HIV, syphilis infection, HCV, NG and CT were 0.1% (95%CI, 0.0-0.2), 1.8% (95%CI, 1.4-2.3), 0.3% (95%CI, 0.1-0.5), 0.3% (95%CI, 0.2-0.5) and 4.3% (95%CI, 3.6-5.0), respectively. Most FSWs (85.6%) reported consistent condom use with clients in the past month. Only 10.6% of FSWs reported group sex, and 68.3% self-reported HIV testing in the previous year. According to the multivariable model, having group sex in the past year (aOR, 2.521, 95%CI: 1.366-4.651) and HIV infection (aOR, 26.260, 95%CI: 2.432-283.563) were associated with a higher risk of syphilis infection. Migrants (aOR, 1.669, 95%CI: 1.163-2.395), having a history of STIs in the past year (aOR, 4.601, 95%CI: 1.003-21.118), and NG infection (aOR, 38.549, 95%CI: 11.214-132.514) were associated with a higher risk of CT infection. On the contrary, FSWs aged older than 25 were associated with lower risk of syphilis infection (25-34: aOR, 0.339, 95%CI: 0.151-0.763) and CT infection (25-34: aOR, 0.503, 95%CI: 0.316-0.802; ≥35: aOR, 0.578, 95%CI: 0.362-0.925).

Conclusion

This study's prevalence rates of syphilis and CT infections show the need to promote comprehensive STIs control and prevention strategies, including behavioral intervention and STIs screening, especially in younger high-risk populations. With the increasing coverage of HIV testing, integrating other STIs screening with HIV testing may be a reasonable way to implement comprehensive STIs control and prevention.

Spatial-temporal analysis of HIV/AIDS and syphilis in mainland China from 2007 to 2017

Human immune deficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and syphilis are the most common sexually transmitted diseases (STDs) worldwide, as well as in China. The objective of this study is to describe the trend of spatial and temporal variation of HIV/AIDS and syphilis in mainland China from 2007 to 2017. Stratified analysis was conducted according to age and the GDP per capita. Estimated Annual Percentage Change (EAPC) was calculated and spatial autocorrelation analysis was used to evaluate the epidemiology and identify clusters. The morbidity of new HIV infection increased from 2.5034/100 000 in 2007 to 6.9247/100 000 in 2017, with an EAPC of 9.84 (95% confidence interval [CI]: 9.07-10.60). From 2007 to 2017, the morbidity of syphilis presented a significant upward trend from 15.8834/100 000 to 34.4867/100 000 (EAPC = 6.48, 95% CI: 4.23-8.73). The number of new HIV infections (205 084) and syphilis (921 279) were highest in the 20-30 years old group, where the incidence decreased with age over 20 years. In general, HIV and syphilis infection had the same incidence trend according to age and time stratification. The morbidity of new HIV infection was mainly reported from Xinjiang and southwestern China. As for syphilis, the highest was found in Zhejiang in Xinjiang and southeast coastal areas. Both HIV and syphilis infection showed a nonrandom positive correlation by Moran's I value. The High-High cluster areas of HIV infection were concentrated in southwestern and eastern China due to syphilis. A highly significant positive correlation was found between gross domestic product per capita and syphilis infection (p < 0.05) but was not associated with HIV infection. The incidence of AIDS/HIV and syphilis is increasing year by year, and a higher prevalence is found in younger individuals. More attention should be paid to HIV infection in the southwest, syphilis in southeast coastal areas, and both the two diseases in Xinjiang.